Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality

BACKGROUND: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of pat...

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Autores: Núñez J, Bayes-Genis, A, Zannad, F, Rossignol, P, Núñez E, Bodi, V, Miñana G, Santas, E, Chorro, FJ, Mollar, A, Carratala, A, Navarro, J, Gorriz, JL, Lupon, J, Husser, O, Metra, M, Sanchis, J
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p1251
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/1251
Access Level:acceso abierto
Palabra clave:cohort studies
heart failure
hyperkalemia
hypokalemia
longitudinal studies
mortality
potassium
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spelling Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of MortalityNúñez JBayes-Genis, AZannad, FRossignol, PNúñez EBodi, VMiñana GSantas, EChorro, FJMollar, ACarratala, ANavarro, JGorriz, JLLupon, JHusser, OMetra, MSanchis, Jcohort studiesheart failurehyperkalemiahypokalemialongitudinal studiesmortalitypotassiumBACKGROUND: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. METHODS: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. RESULTS: The study sample included 2164 patients with a total of 16 116 potassium observations. Mean potassium at discharge was 4.3 +/- 0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5-5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range, 0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a nonlinear association (U-shaped) with higher risk at both ends of its distribution (omnibus P=0.001). Likewise, the adjusted hazard ratios for hypokalemia and hyperkalemia, normokalemia as reference, were 2.35 (95% confidence interval, 1.40-3.93; P=0.001) and 1.55 (95% confidence interval, 1.11-2.16; P=0.011), respectively (omnibus P=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk (P=0.001). CONCLUSIONS: Either modeled continuously or categorically, serum potassium levels during long-term monitoring were independently associated with mortality in patients with heart failure. Likewise, persistence of abnormal potassium levels was linked to a higher risk of death in comparison with patients who maintained or returned to normal values.LIPPINCOTT WILLIAMS & WILKINS2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/1251CIRCULATIONISSN: 00097322ISSNe: 15244539reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p12512026-06-07T16:35:31Z
dc.title.none.fl_str_mv Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
title Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
spellingShingle Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
Núñez J
cohort studies
heart failure
hyperkalemia
hypokalemia
longitudinal studies
mortality
potassium
title_short Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
title_full Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
title_fullStr Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
title_full_unstemmed Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
title_sort Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality
dc.creator.none.fl_str_mv Núñez J
Bayes-Genis, A
Zannad, F
Rossignol, P
Núñez E
Bodi, V
Miñana G
Santas, E
Chorro, FJ
Mollar, A
Carratala, A
Navarro, J
Gorriz, JL
Lupon, J
Husser, O
Metra, M
Sanchis, J
author Núñez J
author_facet Núñez J
Bayes-Genis, A
Zannad, F
Rossignol, P
Núñez E
Bodi, V
Miñana G
Santas, E
Chorro, FJ
Mollar, A
Carratala, A
Navarro, J
Gorriz, JL
Lupon, J
Husser, O
Metra, M
Sanchis, J
author_role author
author2 Bayes-Genis, A
Zannad, F
Rossignol, P
Núñez E
Bodi, V
Miñana G
Santas, E
Chorro, FJ
Mollar, A
Carratala, A
Navarro, J
Gorriz, JL
Lupon, J
Husser, O
Metra, M
Sanchis, J
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv cohort studies
heart failure
hyperkalemia
hypokalemia
longitudinal studies
mortality
potassium
topic cohort studies
heart failure
hyperkalemia
hypokalemia
longitudinal studies
mortality
potassium
description BACKGROUND: The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. METHODS: Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. RESULTS: The study sample included 2164 patients with a total of 16 116 potassium observations. Mean potassium at discharge was 4.3 +/- 0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5-5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range, 0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a nonlinear association (U-shaped) with higher risk at both ends of its distribution (omnibus P=0.001). Likewise, the adjusted hazard ratios for hypokalemia and hyperkalemia, normokalemia as reference, were 2.35 (95% confidence interval, 1.40-3.93; P=0.001) and 1.55 (95% confidence interval, 1.11-2.16; P=0.011), respectively (omnibus P=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk (P=0.001). CONCLUSIONS: Either modeled continuously or categorically, serum potassium levels during long-term monitoring were independently associated with mortality in patients with heart failure. Likewise, persistence of abnormal potassium levels was linked to a higher risk of death in comparison with patients who maintained or returned to normal values.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/1251
url https://incliva.portalinvestigacion.com/publicaciones/1251
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
dc.source.none.fl_str_mv CIRCULATION
ISSN: 00097322
ISSNe: 15244539
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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